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Management of Seizures in Brain Metastases

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Central Nervous System Metastases

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Abstract

Managing epilepsy is integral to diagnosing and treating patients with brain metastases from various systemic malignancies. Seizures are a common symptom in this vulnerable patient population, who often require neurological expertise in conjunction with their oncological care. It is crucial to understand the etiology and diagnostic workup of seizures before formulating an appropriate treatment plan. This chapter provides an overview of seizures in patients with brain metastases, discussing the efficacy of several antiepileptic drugs (AEDs) and the need to balance their respective side effect profiles and interactions with various chemotherapies. In addition to exploring the role of surgery and radiation and their effects on seizure control, we also expand on other important clinical considerations in patients with seizures, including driving restrictions, prophylaxis, and care at the end of life.

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References

  1. Cohen N, Strauss G, Lew R, Silver D, Recht L. Should prophylactic anticonvulsants be administered to patients with newly-diagnosed cerebral metastases? A retrospective analysis. J Clin Oncol. 1988;6(10):1621–4.

    Article  CAS  PubMed  Google Scholar 

  2. Lynam LM, Lyons MK, Drazkowski JF, Sirven JI, Noe KH, Zimmerman RS, et al. Frequency of seizures in patients with newly diagnosed brain tumors: a retrospective review. Clin Neurol Neurosurg. 2007;109(7):634–8.

    Article  PubMed  Google Scholar 

  3. Byrne TN, Cascino TL, Posner JB. Brain metastasis from melanoma. J Neuro-Oncol. 1983;1(4):313–7.

    Article  CAS  Google Scholar 

  4. Chan V, Sahgal A, Egeto P, Schweizer T, Das S. Incidence of seizure in adult patients with intracranial metastatic disease. J Neuro-Oncol. 2017;131(3):619–24.

    Article  Google Scholar 

  5. Chang L, Chen YL, Kao MC. Intracranial metastasis of hepatocellular carcinoma: review of 45 cases. Surg Neurol. 2004;62(2):172–7.

    Article  PubMed  Google Scholar 

  6. Cohen ZR, Suki D, Weinberg JS, Marmor E, Lang FF, Gershenson DM, et al. Brain metastases in patients with ovarian carcinoma: prognostic factors and outcome. J Neuro-Oncol. 2004;66(3):313–25.

    Article  Google Scholar 

  7. Coia LR, Aaronson N, Linggood R, Loeffler J, Priestman TJ. A report of the consensus workshop panel on the treatment of brain metastases. Int J Radiat Oncol Biol Phys. 1992;23(1):223–7.

    Article  CAS  PubMed  Google Scholar 

  8. Glantz MJ, Cole BF, Friedberg MH, Lathi E, Choy H, Furie K, et al. A randomized, blinded, placebo-controlled trial of divalproex sodium prophylaxis in adults with newly diagnosed brain tumors. Neurology. 1996;46(4):985–91.

    Article  CAS  PubMed  Google Scholar 

  9. Goldlust SA, Hsu M, Lassman AB, Panageas KS, Avila EK. Seizure prophylaxis and melanoma brain metastases. J Neuro-Oncol. 2012;108(1):109–14.

    Article  CAS  Google Scholar 

  10. Lee MH, Kong DS, Seol HJ, Nam DH, Lee JI. Risk of seizure and its clinical implication in the patients with cerebral metastasis from lung cancer. Acta Neurochir. 2013;155(10):1833–7.

    Article  PubMed  Google Scholar 

  11. Miabi Z. Metastatic brain tumors: a retrospective review in East Azarbyjan (Tabriz). Acta Med Iran. 2011;49(2):115–7.

    PubMed  Google Scholar 

  12. Mongan JP, Fadul CE, Cole BF, Zaki BI, Suriawinata AA, Ripple GH, et al. Brain metastases from colorectal cancer: risk factors, incidence, and the possible role of chemokines. Clin Colorectal Cancer. 2009;8(2):100–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Posner JB, Chernik NL. Intracranial metastases from systemic cancer. Adv Neurol. 1978;19:579–92.

    CAS  PubMed  Google Scholar 

  14. Raizer JJ, Hwu WJ, Panageas KS, Wilton A, Baldwin DE, Bailey E, et al. Brain and leptomeningeal metastases from cutaneous melanoma: survival outcomes based on clinical features. Neuro-Oncology. 2008;10(2):199–207.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Simionescu MD. Metastatic tumors of the brain: a follow-up study of 195 patients with neurosurgical considerations. J Neurosurg. 1960;17:361–73.

    Article  CAS  PubMed  Google Scholar 

  16. Tremont-Lukats IW, Bobustuc G, Lagos GK, Lolas K, Kyritsis AP, Puduvalli VK. Brain metastasis from prostate carcinoma: The M. D. Anderson Cancer Center experience. Cancer. 2003;98(2):363–8.

    Article  PubMed  Google Scholar 

  17. Wong J, Hird A, Zhang L, Tsao M, Sinclair E, Barnes E, et al. Symptoms and quality of life in cancer patients with brain metastases following palliative radiotherapy. Int J Radiat Oncol Biol Phys. 2009;75(4):1125–31.

    Article  PubMed  Google Scholar 

  18. Zacest AC, Besser M, Stevens G, Thompson JF, McCarthy WH, Culjak G. Surgical management of cerebral metastases from melanoma: outcome in 147 patients treated at a single institution over two decades. J Neurosurg. 2002;96(3):552–8.

    Article  PubMed  Google Scholar 

  19. van Breemen MS, Wilms EB, Vecht CJ. Epilepsy in patients with brain tumours: epidemiology, mechanisms, and management. Lancet Neurol. 2007;6(5):421–30.

    Article  PubMed  Google Scholar 

  20. Beaumont A, Whittle IR. The pathogenesis of tumour associated epilepsy. Acta Neurochir. 2000;142(1):1–15.

    Article  CAS  PubMed  Google Scholar 

  21. You G, Sha Z, Jiang T. The pathogenesis of tumor-related epilepsy and its implications for clinical treatment. Seizure. 2012;21(3):153–9.

    Article  PubMed  Google Scholar 

  22. Fisher RS, Cross JH, French JA, Higurashi N, Hirsch E, Jansen FE, et al. Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58(4):522–30.

    Article  PubMed  Google Scholar 

  23. Theodore WH. The postictal state: effects of age and underlying brain dysfunction. Epilepsy Behav. 2010;19(2):118–20.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Avila EK, Graber J. Seizures and epilepsy in cancer patients. Curr Neurol Neurosci Rep. 2010;10(1):60–7.

    Article  PubMed  Google Scholar 

  25. Fisher RS, Harding G, Erba G, Barkley GL, Wilkins A. Epilepsy Foundation of America Working G. Photic- and pattern-induced seizures: a review for the Epilepsy Foundation of America Working Group. Epilepsia. 2005;46(9):1426–41.

    Article  PubMed  Google Scholar 

  26. Riggs JE. Neurologic manifestations of electrolyte disturbances. Neurol Clin. 2002;20(1):227–39.. vii

    Article  PubMed  Google Scholar 

  27. Burkholder DB, Britton JW, Rajasekaran V, Fabris RR, Cherian PJ, Kelly-Williams KM, et al. Routine vs extended outpatient EEG for the detection of interictal epileptiform discharges. Neurology. 2016;86(16):1524–30.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Hirsch LJ, LaRoche SM, Gaspard N, Gerard E, Svoronos A, Herman ST, et al. American Clinical Neurophysiology Society’s standardized critical care EEG terminology: 2012 version. J Clin Neurophysiol. 2013;30(1):1–27.

    Article  CAS  PubMed  Google Scholar 

  29. Recommendations for neuroimaging of patients with epilepsy. Commission on Neuroimaging of the International League Against Epilepsy. Epilepsia. 1997;38(11):1255–6.

    Article  Google Scholar 

  30. Duncan JS. Imaging and epilepsy. Brain. 1997;120(Pt 2):339–77.

    Article  PubMed  Google Scholar 

  31. Bernal B, Altman NR. Evidence-based medicine: neuroimaging of seizures. Neuroimaging Clin N Am. 2003;13(2):211–24.

    Article  PubMed  Google Scholar 

  32. Swartz BE, Tomiyasu U, Delgado-Escueta AV, Mandelkern M, Khonsari A. Neuroimaging in temporal lobe epilepsy: test sensitivity and relationships to pathology and postoperative outcome. Epilepsia. 1992;33(4):624–34.

    Article  CAS  PubMed  Google Scholar 

  33. Rossetti AO, Stupp R. Epilepsy in brain tumor patients. Curr Opin Neurol. 2010;23(6):603–9.

    Article  CAS  PubMed  Google Scholar 

  34. Usery JB, Michael LM 2nd, Sills AK, Finch CK. A prospective evaluation and literature review of levetiracetam use in patients with brain tumors and seizures. J Neuro-Oncol. 2010;99(2):251–60.

    Article  Google Scholar 

  35. Maschio M, Dinapoli L, Gomellini S, Ferraresi V, Sperati F, Vidiri A, et al. Antiepileptics in brain metastases: safety, efficacy and impact on life expectancy. J Neuro-Oncol. 2010;98(1):109–16.

    Article  CAS  Google Scholar 

  36. Saria MG, Corle C, Hu J, Rudnick JD, Phuphanich S, Mrugala MM, et al. Retrospective analysis of the tolerability and activity of lacosamide in patients with brain tumors: clinical article. J Neurosurg. 2013;118(6):1183–7.

    Article  CAS  PubMed  Google Scholar 

  37. Bedetti C, Romoli M, Maschio M, Di Bonaventura C, Nardi Cesarini E, Eusebi P, et al. Neuropsychiatric adverse events of antiepileptic drugs in brain tumour-related epilepsy: an Italian multicentre prospective observational study. Eur J Neurol. 2017;24(10):1283–9.

    Article  CAS  PubMed  Google Scholar 

  38. van Breemen MS, Rijsman RM, Taphoorn MJ, Walchenbach R, Zwinkels H, Vecht CJ. Efficacy of anti-epileptic drugs in patients with gliomas and seizures. J Neurol. 2009;256(9):1519–26.

    Article  PubMed  Google Scholar 

  39. Maschio M, Zarabla A, Maialetti A, Fabi A, Vidiri A, Villani V, et al. Quality of life, mood and seizure control in patients with brain tumor related epilepsy treated with lacosamide as add-on therapy: a prospective explorative study with a historical control group. Epilepsy Behav. 2017;73:83–9.

    Article  PubMed  Google Scholar 

  40. Ruda R, Pellerino A, Franchino F, Bertolotti C, Bruno F, Mo F, et al. Lacosamide in patients with gliomas and uncontrolled seizures: results from an observational study. J Neuro-Oncol. 2018;136(1):105–14.

    Article  CAS  Google Scholar 

  41. Newton HB, Dalton J, Goldlust S, Pearl D. Retrospective analysis of the efficacy and tolerability of levetiracetam in patients with metastatic brain tumors. J Neuro-Oncol. 2007;84(3):293–6.

    Article  CAS  Google Scholar 

  42. Maschio M, Dinapoli L, Saveriano F, Pompili A, Carapella CM, Vidiri A, et al. Efficacy and tolerability of zonisamide as add-on in brain tumor-related epilepsy: preliminary report. Acta Neurol Scand. 2009;120(3):210–2.

    Article  CAS  PubMed  Google Scholar 

  43. Maschio M, Dinapoli L, Vidiri A, Pace A, Fabi A, Pompili A, et al. The role side effects play in the choice of antiepileptic therapy in brain tumor-related epilepsy: a comparative study on traditional antiepileptic drugs versus oxcarbazepine. J Exp Clin Cancer Res. 2009;28:60.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  44. Perry JR, Sawka C. Add-on gabapentin for refractory seizures in patients with brain tumours. Can J Neurol Sci. 1996;23(2):128–31.

    Article  CAS  PubMed  Google Scholar 

  45. Novy J, Stupp R, Rossetti AO. Pregabalin in patients with primary brain tumors and seizures: a preliminary observation. Clin Neurol Neurosurg. 2009;111(2):171–3.

    Article  PubMed  Google Scholar 

  46. Maschio M, Dinapoli L, Zarabla A, Pompili A, Carapella CM, Pace A, et al. Outcome and tolerability of topiramate in brain tumor associated epilepsy. J Neuro-Oncol. 2008;86(1):61–70.

    Article  CAS  Google Scholar 

  47. Berger MS, Ghatan S, Haglund MM, Dobbins J, Ojemann GA. Low-grade gliomas associated with intractable epilepsy: seizure outcome utilizing electrocorticography during tumor resection. J Neurosurg. 1993;79(1):62–9.

    Article  CAS  PubMed  Google Scholar 

  48. Blonski M, Taillandier L, Herbet G, Maldonado IL, Beauchesne P, Fabbro M, et al. Combination of neoadjuvant chemotherapy followed by surgical resection as a new strategy for WHO grade II gliomas: a study of cognitive status and quality of life. J Neuro-Oncol. 2012;106(2):353–66.

    Article  CAS  Google Scholar 

  49. Koekkoek JA, Dirven L, Heimans JJ, Postma TJ, Vos MJ, Reijneveld JC, et al. Seizure reduction in a low-grade glioma: more than a beneficial side effect of temozolomide. J Neurol Neurosurg Psychiatry. 2015;86(4):366–73.

    Article  PubMed  Google Scholar 

  50. Taillandier L, Duffau H. Epilepsy and insular grade II gliomas: an interdisciplinary point of view from a retrospective monocentric series of 46 cases. Neurosurg Focus. 2009;27(2):E8.

    Article  PubMed  Google Scholar 

  51. Sherman JH, Moldovan K, Yeoh HK, Starke RM, Pouratian N, Shaffrey ME, et al. Impact of temozolomide chemotherapy on seizure frequency in patients with low-grade gliomas. J Neurosurg. 2011;114(6):1617–21.

    Article  PubMed  Google Scholar 

  52. Pace A, Vidiri A, Galie E, Carosi M, Telera S, Cianciulli AM, et al. Temozolomide chemotherapy for progressive low-grade glioma: clinical benefits and radiological response. Ann Oncol. 2003;14(12):1722–6.

    Article  CAS  PubMed  Google Scholar 

  53. Brada M, Viviers L, Abson C, Hines F, Britton J, Ashley S, et al. Phase II study of primary temozolomide chemotherapy in patients with WHO grade II gliomas. Ann Oncol. 2003;14(12):1715–21.

    Article  CAS  PubMed  Google Scholar 

  54. Mikkelsen T, Paleologos NA, Robinson PD, Ammirati M, Andrews DW, Asher AL, et al. The role of prophylactic anticonvulsants in the management of brain metastases: a systematic review and evidence-based clinical practice guideline. J Neuro-Oncol. 2010;96(1):97–102.

    Article  Google Scholar 

  55. Forsyth PA, Weaver S, Fulton D, Brasher PM, Sutherland G, Stewart D, et al. Prophylactic anticonvulsants in patients with brain tumour. Can J Neurol Sci. 2003;30(2):106–12.

    Article  PubMed  Google Scholar 

  56. Benit CP, Vecht CJ. Seizures and cancer: drug interactions of anticonvulsants with chemotherapeutic agents, tyrosine kinase inhibitors and glucocorticoids. Neuro-Oncol Pract. 2016;3(4):245–60.

    Article  Google Scholar 

  57. Chen JW, Wasterlain CG. Status epilepticus: pathophysiology and management in adults. Lancet Neurol. 2006;5(3):246–56.

    Article  PubMed  Google Scholar 

  58. Husain AM, Horn GJ, Jacobson MP. Non-convulsive status epilepticus: usefulness of clinical features in selecting patients for urgent EEG. J Neurol Neurosurg Psychiatry. 2003;74(2):189–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Towne AR, Waterhouse EJ, Boggs JG, Garnett LK, Brown AJ, Smith JR Jr, et al. Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology. 2000;54(2):340–5.

    Article  CAS  PubMed  Google Scholar 

  60. Marcuse LV, Lancman G, Demopoulos A, Fields M. Nonconvulsive status epilepticus in patients with brain tumors. Seizure. 2014;23(7):542–7.

    Article  PubMed  Google Scholar 

  61. Ma BB, Bloch J, Krumholz A, Hopp JL, Foreman PJ, Soderstrom CA, et al. Regulating drivers with epilepsy in Maryland: results of the application of a United States consensus guideline. Epilepsia. 2017;58(8):1389–97.

    Article  PubMed  Google Scholar 

  62. Consensus statements, sample statutory provisions, and model regulations regarding driver licensing and epilepsy. American Academy of Neurology, American Epilepsy Society, and Epilepsy Foundation of America. Epilepsia. 1994;35(3):696–705.

    Article  Google Scholar 

  63. Sheth SG, Krauss G, Krumholz A, Li G. Mortality in epilepsy: driving fatalities vs other causes of death in patients with epilepsy. Neurology. 2004;63(6):1002–7.

    Article  PubMed  Google Scholar 

  64. Krauss GL, Krumholz A, Carter RC, Li G, Kaplan P. Risk factors for seizure-related motor vehicle crashes in patients with epilepsy. Neurology. 1999;52(7):1324–9.

    Article  CAS  PubMed  Google Scholar 

  65. Drazkowski JF, Fisher RS, Sirven JI, Demaerschalk BM, Uber-Zak L, Hentz JG, et al. Seizure-related motor vehicle crashes in Arizona before and after reducing the driving restriction from 12 to 3 months. Mayo Clin Proc. 2003;78(7):819–25.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Ankush Bhatia & Edward K. Avila

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  1. Ankush Bhatia
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  2. Edward K. Avila
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Correspondence to Edward K. Avila .

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Editors and Affiliations

  1. Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, Director - Brain Metastases Program, New York, NY, USA

    Rohan Ramakrishna

  2. Department of Neurology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA

    Rajiv S. Magge

  3. Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA

    Ali A. Baaj

  4. Department of Radiation Oncology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA

    Jonathan P.S. Knisely

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Bhatia, A., Avila, E.K. (2020). Management of Seizures in Brain Metastases. In: Ramakrishna, R., Magge, R., Baaj, A., Knisely, J. (eds) Central Nervous System Metastases. Springer, Cham. https://doi.org/10.1007/978-3-030-42958-4_9

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  • DOI: https://doi.org/10.1007/978-3-030-42958-4_9

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